Provider Demographics
NPI:1881713428
Name:NICOLETTI, MICHELLE I (DNP, RN, FNP-BC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:I
Last Name:NICOLETTI
Suffix:
Gender:F
Credentials:DNP, RN, FNP-BC
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:PO BOX 21327
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76702-1327
Mailing Address - Country:US
Mailing Address - Phone:254-399-5441
Mailing Address - Fax:254-776-7121
Practice Address - Street 1:7125 NEW SANGER AVE STE A
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-4054
Practice Address - Country:US
Practice Address - Phone:254-399-5400
Practice Address - Fax:254-772-8669
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX251376363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX327807901Medicaid